DOI: 10.1177/20584601241228220 ISSN: 2058-4601

A multi-institutional assessment of low-dose protocols in chest computed tomography: Dose and image quality

Elena Tonkopi, Mercy Afadzi Tetteh, Catherine Gunn, Haseem Ashraf, Sigrid Lia Rusten, Perkhah Safi, Nora Suu Tinsoe, Kylie Colford, Olivia Ouellet, Salma Naimi, Safora Johansen
  • General Earth and Planetary Sciences
  • General Environmental Science


Low-dose CT (LDCT) chest protocols have widespread clinical applications for many indications; as a result, there is a need for protocol assessment prior to standardization. Dalhousie University and Oslo Metropolitan University have a formally established cooperative relationship.


The purpose is to assess radiation dose and image quality for LDCT chest protocols in seven different hospital locations in Norway and Canada.

Material and methods

Retrospective dosimetry data, volumetric CT dose index (CTDIvol), and dose length product (DLP) from 240 average-sized patients as well as CT protocol parameters were included in the survey. Effective dose (ED) and size-specific dose estimate (SSDE) were calculated for each examination. For a quantitative image quality analysis, noise, CT number, and signal-to-noise ratio (SNR) were determined for three regions in the chest. The contrast-to-noise ratio (CNR) was calculated for lung parenchyma in comparison to the subcutaneous fat. Differences in dose and image quality were evaluated by a single-factor ANOVA test. A two-sample t-test was performed to determine differences in means between individual scanners.


The ANOVA test revealed significant differences ( p < .05) in dose values for all scanners, including identical scanner models. Statistically significant differences ( p < .05) were determined in mean values of the SNR distributions between the scanners in all three measured regions in the chest, as well as the CNR values.


The observed variations in dose and image quality measurements, even within the same hospitals and between identical scanner models, indicate a potential for protocol optimization in the involved hospitals in both countries.

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